Sue Lani Madsen comments on current events, context, community, country living and conservative values, and tries not to get carried away by alliteration. She is an architect, rancher, writer and volunteer firefighter/EMT from eastern Washington.

If Not This, Then What – Part 1

We have bi-partisan agreement that we have problems with our health care system in the United States, but we don’t yet have a bi-partisan solution. It’s not a system in any formally connected sense, and using the language of “system” to describe it is getting us off track from the very start of the problem seeking process. Code Blue Now is a non-profit organization that used a scientifically based survey process in Iowa and Washington to develop a Voters Platform that amounts to a pretty good problem statement (link here for background):

• Assure everyone has coverage.
• Keep a private insurance market, but build in accountability. Hold insurers accountable for cost, quality, efficiency and customer service. Doctors keep private practices and individuals see their licensed provider of choice.
• Define a basic benefit package all would have. That would lead to administrative simplicity and savings, which could be redirected toward patient care and greater opportunity and freedom because people could choose any job, without fear of losing benefits. Those wanting more benefits can buy more, as they do now. And everyone pays — individual, employer and government.
• Reward patients and providers for supporting the health of the patient, improve care for chronic conditions, create incentives to keep people well, while not penalizing those with conditions beyond their control.
• Use existing agencies to manage the benefits at the state level and let people choose health savings accounts like 401(k) plans that they can use for health care and long-term care.

Let’s start with the first platform statement – assure everyone has coverage – and break it down. What does “assure” mean? From my point of view and based on later statements in the platform referencing a private insurance market and health savings accounts, government need not provide coverage but must remove barriers to access to coverage and enable individual choices.

Who is “everyone” and how many of them are there? The U.S. Census Bureau best estimate, as quoted in the Wall Street Journal On-Line on June 24, 2009 (link here), is 45.7 million uninsured in the United States. The estimate is based on 30 different assumptions, any of which may be flawed and all of which are currently being debated in statistical circles. For example, people who don’t answer the health care questions when surveyed are counted as much more likely to be uninsured, but alternative modeling may result in an adjustment of 2.5 million fewer people counted as uninsured according to the WSJ. Some surveys only include people who have landline phones, which simply leaves out a growing chunk of the population. The 45.7 million also includes assumptions about illegal aliens, which range from 6 – 10 million of the total. Assuming we aren’t committing to assure coverage to people who are here illegally, the 45.7 million would be reduced to somewhere between 33.2 million and 37.2 million after adjusting for two out of 30 assumptions. That also leaves the nagging reality of what to do about sick people who should lawfully be deported and turn up at a hospital anyway; let’s set that aside for now and test the last part of the statement.

We’ve now agreed that we are going to assure everyone “has coverage.” Sounds like a requirement to purchase insurance, but if we are going to require it, we need a lot of choice of what that coverage includes. Coverage for what? According to my reading of the rest of the platform, it would be coverage under private insurance, with at least a basic benefit package, with incentives for staying well and no penalty for conditions out of individual control, and with health savings account options so people can manage their own money.

The trickiest part of the whole coverage definition is defining basic. As the state of Washington has discovered in attempting to define basic coverage through mandates, the mandates can quickly grow out of control. Centrally defined basic coverage tends to either disadvantage folks by leaving out what they consider basic (homeopathic treatment, for example) or by including things they don’t want but which had effective lobbyists (massage therapy, for example, and I say that as someone who really values good massage therapy for computer neck!).

And that was only the first four words in the platform! I’ll leave the rest of the platform and possible solutions for If Not This, Then What – Part 2. Right now I need to go outside and do two things that really will make a difference to my health – exercise as I weed the garden and harvesting fresh vegetables for a healthy diet.